Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan.
Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori, Miyagi 981-1293, Japan.
Auris Nasus Larynx. 2022 Feb;49(1):141-146. doi: 10.1016/j.anl.2021.06.004. Epub 2021 Jul 1.
Early enteral nutrition is essential for enhancing recovery after surgery. However, to date, no detailed study has been conducted on the feasibility of early enteral nutrition in patients undergoing head and neck surgery with free tissue transfer reconstruction (HNS-FTTR) and the risk factors for difficulty with early enteral nutrition.
We retrospectively analyzed 102 patients who underwent HNS-FTTR at our institution; 61 underwent free jejunal reconstruction (FJ) and 41 did not. We investigated the achievement of early enteral nutrition within 24 and 48 h after surgery and the discontinuation of enteral nutrition after its initiation within 7 days after surgery.
Enteral nutrition could be started in 81/102 (79.4%) and 99/102 (97.1%) patients within 24 and 48 h, respectively. Cases of difficulty with early enteral nutrition accounted for 21/102 (20.6%) patients. The multivariate analysis revealed that FJ was a significant independent risk factor for difficulty with early enteral nutrition (odds ratio: 4.054, P = 0.042). The risk factors for difficulty with early enteral nutrition in patients who underwent FJ were also investigated, and the multivariate analysis showed that blood loss of ≥158 mL was a significant independent risk factor (odds ratio: 3.505, P = 0.044).
Early enteral nutrition seemed to be provided with no problems in patients without FJ. FJ was a significant risk factor for difficulty with early enteral nutrition. Increased intraoperative blood loss was a significant risk factor for difficulty with early enteral nutrition in patients undergoing FJ; therefore, patients' abdominal symptoms and gastric residual volume should be carefully monitored in such cases.
早期肠内营养对于促进头颈部游离组织移植重建（HNS-FTTR）术后康复至关重要。然而，迄今为止，尚无详细研究探讨头颈部游离组织移植重建术后早期肠内营养的可行性及其相关困难的危险因素。
我们回顾性分析了在我院行 HNS-FTTR 的 102 例患者，其中 61 例行游离空肠重建（FJ），41 例未行 FJ。我们研究了术后 24 和 48 小时内开始早期肠内营养的情况，以及术后 7 天内开始肠内营养后停止的情况。
81/102（79.4%）和 99/102（97.1%）例患者分别在术后 24 和 48 小时内可以开始肠内营养。21/102（20.6%）例患者存在早期肠内营养困难。多因素分析显示，FJ 是早期肠内营养困难的独立危险因素（比值比：4.054，P=0.042）。进一步对行 FJ 的患者中早期肠内营养困难的危险因素进行了研究，多因素分析显示，出血量≥158ml 是独立的危险因素（比值比：3.505，P=0.044）。
未行 FJ 的患者似乎可以顺利开始早期肠内营养。FJ 是早期肠内营养困难的独立危险因素。术中出血量增加是行 FJ 的患者早期肠内营养困难的独立危险因素，因此，在这种情况下应密切监测患者的腹部症状和胃残留量。
